Cor triatriatum sinistrum is a rare congenital disorder defined as a division of the left atrium by a diaphragmatic membrane resulting in two left atrial chambers. The membranous division of the atrium can be partial or complete and can affect either atrium, with involvement of the right atrium referred to as cor triatriatum dexter. The presence of fenestrations within the membrane allows for communication and forward passage of blood into the true atrium. Absence of fenestrations leads to early symptomatic engorgement of the lungs. We report the case of a young adult male presenting with recurrent hematemesis due to variceal bleeding. On CT imaging the patient was found to have cor triatriatum sinistrum, with a vertical membrane resulting in total obstruction of the pulmonary venous drainage on the right, with normal pulmonary venous drainage on the left. There was extensive pulmonary-systemic arterial collateralization to the right lung suggesting retrograde filling of the right pulmonary artery with effective flow reversal in the right lung.
A 43-year-old female presented with flank pain of two days duration. She had been admitted previously for bilateral lower extremity edema which had not improved with diuresis. Abdominal Imaging showed left ovarian vein thrombosis and left renal vein thrombosis extending into the IVC. Chest imaging revealed right lower lobe segmental pulmonary emboli. Careful review of serial urinalysis during previous admissions revealed significant proteinuria. Confirmatory urine tests followed by a renal biopsy led to a diagnosis of membranous nephropathy. We report a case of acute diffuse thromboembolism due to membranous nephropathy, unmasked by serial abnormal urinalysis.
The treatment of interstitial lung disease usually has consisted of corticosteroids with or without either azathioprine or cyclophosphamide. These drugs mainly target the neutrophil. Recently, the role of the Th2 lymphocyte leading to fibrosis has been demonstrated in animal models and preliminary human studies. This finding has led to interest in cytokine therapy with the interferon treatments, which reduce the Th2 response. Other new treatments have focused specifically on the fibroblast or oxygen free radicals. The range of treatment for interstitial lung diseases is increasing. Current clinical trials are in progress to confirm the pilot studies recently reported. The future therapy of interstitial lung disease probably will consist of multiple agents aimed at several aspects of the inflammatory reaction of interstitial lung disease.
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